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Table of Contents
Vol. 45, No. 2, 2009
Issue release date: April 2009
Section title: Case Report
Pediatr Neurosurg 2009;45:146–150
(DOI:10.1159/000209654)

Decompressive Hemicraniectomy in a 19-Month-Old Female after Malignant Cerebral Infarction

Farooq M.U. · Abbed K.M. · Fletcher J.J.
aDepartment of Neurology and Ophthalmology, Michigan State University, East Lansing, Mich., bDepartment of Neurology and Neurocritical Care, Michigan State University, Bronson Methodist Hospital, Kalamazoo, Mich., and cDepartment of Neurosurgery, Yale School of Medicine, New Haven, Conn., USA

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Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: 7/31/2008
Accepted: 12/15/2008
Published online: 3/25/2009

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 0

ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)

For additional information: http://www.karger.com/PNE

Abstract

Malignant cerebral infarction is a life-threatening condition with case fatality rates of approximately 80% in adults with malignant infarction of the middle cerebral artery. No medical treatment has been proven effective for this condition. Decompressive hemicraniectomy within 48 h of massive cerebral infarction significantly reduces mortality and improves outcome in adults 18–60 years of age. However, there is very limited data available about the role of decompressive hemicraniectomy in children with acute malignant cerebral infarction. We present the case of a 19-month-old female who presented with progressive encephalopathy and right hemiparesis. Computed tomography and magnetic resonance imaging of the brain showed massive cerebral infarction in the distribution of the left carotid artery with midline shift and impeding brain stem herniation. She underwent emergent decompressive hemicraniectomy with duraplasty and placement of an intracranial pressure monitor. Intracranial pressure was controlled with sedation and the patient was extubated on postoperative day 4. Extensive stroke workup was negative. Cranioplasty was performed at 3 months post-op. At the 6-month follow-up, she had an excellent recovery (modified Rankin scale of 1). Decompressive hemicraniectomy should be considered for the treatment of cerebral edema in children with malignant cerebral infarction. This may improve mortality and functional outcome compared to medical therapy alone. Due to the rare occurrence of stroke in children, more reports of decompressive hemicraniectomy are encouraged.


Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: 7/31/2008
Accepted: 12/15/2008
Published online: 3/25/2009

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 0

ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)

For additional information: http://www.karger.com/PNE


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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    External Resources

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